The silent epidemic: How hearing loss is ignored

Loss of hearing isn't the only ear problem bringing misery to millions. Yet from dizziness to constant buzzzing, these soul-destroying conditions are often ignored.

Deafness as a result of old age is an extremely common problem, affecting millions of Britons. However, there are also many people - including those in their 20s and 30s - who suffer from other types of ear complaints that can be just just as distressing.

The ears are vital for balance as well as for relaying sounds to the brain. If you stumble, it is the ears that register this and alert the brain to take action to stop you falling over. Little wonder, then, that a problem with the ears can have a huge impact on well-being.

'A lot of conditions of the ear are tremendously debilitating,' says Dr Josephine Marriage, a research associate at Cambridge University who specialises in ear disorders.

'People with Meniere's disease, for example, suffer from such severe vertigo - a feeling of spinning caused by a problem in the inner ear - that it can leave them collapsed in a heap on the floor.'

Not only do they receive little sympathy - sufferers invariably look well - but even their medics tend to offer little in the way of help, says Professor Tony Wright, an ear surgeon at University College Hospital, London. 'People are not offered the help they should be, and the problem can get worse, as can the sense of isolation that accompanies these conditions.'

'One of the problems is that not all medical schools offer training in Ear, Nose and Throat, even though ENT patients make up around 10 per cent of a GP's caseload,' he says.

While little is being done to help people with ear complaints, the incidence is rising. The number affected by tinnitus, for example, is predicted to double in the next ten years, to 16per cent of the population.

There are several reasons ear problems are becoming more commonplace, says Professor Wright. 'Some symptoms of some ear complaints are stress-related, and as stress levels have increased so have these conditions.

'We in the profession also fear the long-term effect of the iPod generation. Listening to loud noises for a long time through headphones can damage the inner ear, and in the years ahead we expect a dramatic rise in hearing loss and other ear problems.'

Here is a guide to the most common earrelated conditions, their symptoms and the treatment available. . .

TINNITUS

SYMPTOMS: Ringing, buzzing, humming or even singing sounds in the ear. Often worse in the evening, when other background noise is reduced.

CAUSES: The background noise is caused when the brain receives sound signals, despite there being no noise to detect. It's not clear why this happens, although stress is thought to be a major factor. Research suggests that sufferers have low levels of serotonin - the so-called feel-good chemical in the brain.

Tinnitus is also a side-effect of high doses of certain drugs, including aspirin, diuretics and chemotherapy, but again it's not known why.

In very rare cases it may be a sign of another underlying condition, such as a tumour near the nerve that runs from the ear to the brain. Tinnitus, which can affect one or both ears, affects 2.3 million adults in the UK. Around 30,000 people have it so badly that it prevents them from leading a normal life.

TREATMENT: Relaxation techniques and CDs of natural sounds can help switch the focus away from the tinnitus. Using speakers under your pillow may help.

Researchers are studying the use of antidepressant drugs to boost serotonin levels, and brain pacemakers and pulsing, magnetic waves to stop the false sound messages.

Carol Simpson, 43, is an administration officer for the London Fire Brigade and lives in Peckham, South-East London. She says:

My problems began two months into chemotherapy treatment for bone and lung cancer. Of course, I am lucky to have survived, but for the past 15 years I have suffered from tinnitus as a result. Every minute of every day I hear ringing in my ears.

Sometimes it is so loud I can barely hear what other people are saying, and for years it stopped me sleeping more than four or so hours a night and I would crawl to work.

For ten years I didn't seek help because I presumed nothing could be done. Then, I had a hearing test for a new job, and they told me about the Tinnitus Association.

I've learned to cope by focusing on something else so I can almost ignore the ringing noise. At work I am generally OK. However, at home it gets really bad, and if I get stressed or have a headache, the ringing is almost deafening.

I bought a machine that plays the sounds of the sea, which I put on when I go to bed, and that helps no end.

The British Tinnitus Association; www.tinnitus.org.uk; 0800 018 0527

MENIERE'S DISEASE

SYMPTOMS: Sudden attacks of giddiness (vertigo) that can last for days, in some cases accompanied by nausea and vomiting; persistent buzzing in the ears; fluctuating hearing loss; a feeling of pressure in the affected ear; slight giddiness all time, but worse in the dark.

CAUSES: Our sense of balance is determined by fluid in the labyrinth, a series of canals in the inner ear. This fluid shifts as we move and signals to the brain to take action to steady us.

In Meniere's disease, it is thought that pressure builds in the fluid, causing inflammation; this destroys both the labyrinth and the cochlea, which assists hearing. As a result, the ear sends incorrect messages to the balance centre in the brain. In most cases only one ear is affected.

The condition is progressive, leading to constant balance problems.

There's a family link in ten per cent of cases - this is not genetic, but some catalyst in the home environment.

Those who suffer from migraines, viral infections and allergies are at slightly increased risk of the disease. Meniere's affects around 25,000 people in the UK.

TREATMENT: Drugs such as betahistine and diuretics can help prevent vertigo attacks by reducing the risk of pressure building up in the fluid in the inner ear; anti-nausea drugs may prevent sickness. Exercises - using slight movements to the head and eyes - are used to retrain the brain so it doesn't rely on the ears for balance.

For extreme cases a drug called gentamicin is used to 'kill off' the part of the labyrinth that controls balance - this stops the muddled messages reaching the brain.

Patients then need rehabilitation exercises to retrain their brain. Surgical options include a vestibular nerve section, in which the nerve from inner ear to brain is cut.

Julia Davies, 35, a project manager, lives with her partner in Yaxley, Peterborough. She says:

There have been times when I have felt so giddy I do not know which way is up. The slightest turn of the head can sometimes make my head spin. It began gradually five years ago with slight feelings of dizziness. My doctor put it down to overwork.

However, within months it had got so bad I would wake up with the room spinning. For four or more hours I would be unable to move because everything felt as if I was at sea. I was unable to work and decided to see a private consultant as I couldn't face months of waiting on the NHS.

Two months after it started I was diagnosed with Meniere's. Mine was such a severe case the consultant suggested surgery to administer gentamicin.

Ten months later I was finally able to go back to work, although I still suffered from giddiness, especially in places with aisles, such as supermarkets. My job as a warehouse manager became impossible and I had to become office-based.

I still had two or three vertigo attacks a year and last November I had more gentamicin treatment. No one can tell me what will happen in the long term. I am just hoping for the best.

The Meniere's Society; www.menieres.org.uk; 0845 1202 975

LABYRINTHITIS

SYMPTOMS: Starts with a sudden attack of dizziness or vertigo together with hearing loss; nausea; vomiting; a constant flickering of the eyes. Symptoms are similar to Meniere's, but less persistent.

CAUSES: An inflammation in the inner ear can affect both the cochlea, which helps amplify sound, and the labyrinth - the tunnels that contain fluid which maintains the sense of balance. Inflammation may be caused by a common viral infection, such as shingles, or bacterial infection, such as bacterial meningitis.

Vestibular labyrinthitis, which is confined to the labyrinth, affects hundreds of thousands a year, peaking in the autumn when viral infections are more commonplace. Although it usually clears up in three weeks, for some the symptoms last for months, even years.

TREATMENT: Some patients may need drug treatment for bacterial infection, or to prevent the dizziness or nausea. Where there is long-term damage, balance rehabilitation exercises (taught by audiologists) can help to retrain the brain to balance the body.

Kevin Lamb, 41, an IT administrator from Grays, Essex, is married with two teenage children. He says:

Last April I was at my goddaughter's christening when suddenly I felt as if the room was spinning. I was so giddy I had to reach out to hold myself up. The next day I felt just as bad and battled my way to the doctor's, holding onto walls and fighting the sensation that I had just come off a roller-coaster. I also felt nauseous.

My GP diagnosed labyrinthitis and told me to rest. After two weeks I felt better, but a few weeks later I started getting dizzy spells again and they have continued once a week or so.

A specialist gave me a series of exercises to teach my brain to rebalance. They make me feel giddy, but I am assured they will make me feel better in the long run.

www.labyrinthitis.org.uk

OTOSCLEROSIS

SYMPTOMS: Hearing loss, especially in noisy surroundings; sometimes buzzing or ringing in the ears; sufferers tend to start talking more quietly than normal.

CAUSES: The fine, moveable bones behind the eardrum - the ossicles - help to push sounds through to the inner ear, where they are amplified.

The end ossicle is called the stapes. In people with otosclerosis, extra bone forms over the stapes causing it to become fixed, stopping sounds being transferred to the inner ear. This condition is a major cause of deafness and often starts when people are in their 20s or 30s. More than a million Britons are affected, and it is more common in women.

TREATMENT: Sufferers may need to use a hearing aid or have a stapedectomy - the stapes are replaced with a moveable piston-shaped device. Surgery has a success rate of around 80 per cent.

Ian Bretman, 52, is deputy director of the Fair Trade Foundation and lives in London with his wife and two children. He says:

During my early 30s I started to notice that I could not hear very well, especially when there was background noise. People thought I was being rude as I would not reply to them at gatherings. Really, it was because I could not hear them.

My GP diagnosed otosclerosis. He said surgery might help in the long run, so when I was 40 I decided to have a stapedectomy through private health insurance.

It was immediately obvious that something had gone wrong as when I came round I could not sit up without feeling giddy and had no hearing in my left ear. The operation had not worked and I was told I'd never hear again in that ear.

I managed by straining to hear what was said, but a couple of years ago I started to lose the hearing in my right ear, too.

Another operation was too risky, so now I have a hearing aid which gives me 25 per cent of my total hearing. I can only watch TV if there are subtitles and recently I bought a vibrating clock to put under my pillow to wake me up. I've also developed back and neck problems through leaning forward to hear. But I am determined not to let this beat me.

SYMPTOMS: Moderate or loud noise causes pain in the ear, lasting for hours or even days; ear feels sore or aches; anxiety over fear of loud noises.

CAUSES: Sounds picked up by the ear are carried to the brain with the help of certain chemicals. It's thought a lack of these chemicals makes people overly sensitive to everyday sounds. Head injuries and exposure to loud noises can cause this, as can stress. Affects around eight per cent of adults and six per cent of children.

TREATMENT: Auditory 'desensitisation' trains sufferers to tolerate increased noise. Some people use ear muffs or plugs when they go out. 'Maskers' or white noise machines, which look like a hearing aid but play continual low-grade noise into the ear, can help improve sensitivity to noise.

Niki Potterton, 28, is a DJ from Camberley, Surrey. She says:

Five years ago I was playing at a gig in Ibiza. The volume button on the deck was broken and turned up to the highest level, which made the noise in my headphones really blare out. The next act failed to turn up so I had to continue like this for six hours.

Afterwards my left ear felt numb. The next day it throbbed and I could barely hear a thing. I was terrified and in tears. My GP said there was no damage to the drum, but that I should be more careful in future.

I was relieved when three days later my hearing came back, but when it did everything sounded louder. On the telephone it sounded as if people were shouting, and I've had to get special earphones to tone down the noise for my work. Otherwise it's agony.